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Individual
MRS. KELLY DIANNE DIXON
Active
Individual
MRS. KELLY DIANNE DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-AUDIOLOGY
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
1577
TN
231H00000X
Audiologist
2201001486
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1577
ST LIC
TN
05
—
1780903823
—
VA
01
—
2201001486
VA STATE LIC
VA
Enumeration date
05/28/2010
Last updated
04/05/2019
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